title: Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME? Results of a case-control study.
abstract: OBJECTIVE
  Intraoperative neuromonitoring (IONM) aims to control nerve-sparing total mesorectal excision (TME) for rectal cancer in order to improve patients' functional outcome. This study was designed to compare the urogenital and anorectal functional outcome of TME with and without IONM of innervation to the bladder and the internal anal sphincter.
  
  
  METHODS
  A consecutive series of 150 patients with primary rectal cancer were analysed. Fifteen match pairs with open TME and combined urogenital and anorectal functional assessment at follow up were established identical regarding gender, tumour site, tumour stage, neoadjuvant radiotherapy and type of surgery. Urogenital and anorectal function was evaluated prospectively on the basis of self-administered standardized questionnaires, measurement of residual urine volume and longterm-catheterization rate.
  
  
  RESULTS
  Newly developed urinary dysfunction after surgery was reported by 1 of 15 patients in the IONM group and by 6 of 15 in the control group (p = 0.031). Postoperative residual urine volume was significantly higher in the control group. At follow up impaired anorectal function was present in 1 of 15 patients undergoing TME with IONM and in 6 of 15 without IONM (p = 0.031). The IONM group showed a trend towards a lower rate of sexual dysfunction after surgery.
  
  
  CONCLUSIONS
  In this study TME with IONM was associated with significant lower rates of urinary and anorectal dysfunction. Prospective randomized trials are mandatory to evaluate the definite role of IONM in rectal cancer surgery.
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Medicine of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany. Electronic address: werner.kneist@unimedizin-mainz.de.
authors.forename: W
authors.initials: W
authors.lastname: Kneist
authors.forename: D W
authors.initials: DW
authors.lastname: Kauff
authors.forename: V
authors.initials: V
authors.lastname: Juhre
authors.forename: K P
authors.initials: KP
authors.lastname: Hoffmann
authors.forename: H
authors.initials: H
authors.lastname: Lang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000294:innervation*; D017776:Autonomic Pathways; D016022:Case-Control Studies; D015331:Cohort Studies; D005242:Fecal Incontinence / Q000517:prevention & control; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D059351:Organ Sparing Treatments; D059348:Peripheral Nerve Injuries / Q000517:prevention & control*; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000601:surgery*; D012007:Rectum / Q000601:surgery*; D012735:Sexual Dysfunction, Physiological / Q000517:prevention & control; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000294:innervation*
keywords: Anal sphincter; Autonomic nerves; Electric stimulation; Electromyography; Intraoperative monitoring; Rectal cancer